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MCC Susan chest tube
MCC Susan chest tube lecture and video
| Question | Answer |
|---|---|
| tension pneumothorax | if chest tube falls out and someone covers it then traps air in and expands/extends pneumo. rapid medical emergency. leads to mediastinal shift |
| burp flap | tape hole where chest tube was on 3 sides so that air can escape but not enter. do not use gloved hand or occlusive dressing to cover hole |
| mediastinal shift/tracheal deviation | result of tension pneumothorax then compressess the other side (heart) and leads to death |
| open pneumothorax | stabbing |
| closed pneumothorax | crushed ribs |
| hemothorax | SHOCK is result |
| flail chest | fractures on both side of rib |
| pneumothorax | air in pleural space. sharp stabing pain. cardiac is pressure, not sharp |
| hemothorax | blood in pleural space |
| pneumo and hemothorax s & s | Dyspnea, Diminished or absent breath sounds |
| pneumo hemothorax tx | chest tube. assist with insertion. 24-36 french Place occlusive (ABD) bandage (to keep air out) around tube and cover with two inch tape. Also use occlusive after tube removal. May possibly use Vaseline gauze around tube, petroleum could go in lung |
| Heimlich valve | pneumothorax tx, NOT hemothorax tx. air can’t get in, but can get out, need vented bag |
| tension pneumothorax tx | 14g needle decompression |
| pleurodesis know | chest tube instert then talc or doxyclcin to keep pleura from separation. Hemothorax tx if pleural effusion present |
| pleural effusion | not blood, r/t hemothorax & cancer |
| occlusive vs burp flap dressing | burp flap if tube falls out so air goes in and out, oclusive (ABD) bandage around tube to keep air out but risk of petroleum getting in lung |
| Suction | Dry -> sx @ 80 mmHg; Wet -> mod, cont bubble |
| Water Seal | Tital (norm); 0 Tital -> kink/ full expanded; Bubbles -> air leak |
| Drainage | check output Q1H; call if > 100hr or <prior. Different for mediastinal drain (CABG) |
| dependent loop | with chest tube keep loops high so fluid doesn't stay in loop and create tension pneumothorax. could kill with a dependent loop |
| chest tube purpose | remove: pneumothorax (air); pleural effusion (fluid); hemothorax (blood); empyema (pus) |
| 2. During inspiration, the intercostals and diaphragm ________ and the negative pressure provides that the lungs fill with air | CONTRACT |
| 3. During exhalation, the intercostals and diaphragm ________ so that the air can get out. | RELAX |
| 4. The parietal pleura is on the ______side. | thorax |
| 5. The visceral pleura is on the ______ side. | LUNGS |
| 6. What is the function of pleural fluid? | lubricate |
| 8. A tension pneumothorax can cause a? | media stinal shift leading to cardiac arrest shift. Medical emergency, need to decompress w/ 14 ga needle |
| 9. A chest tube is inserted into the pleural space so that the lung can ? | expand |
| 7. A tension pneumothorax can lead to? | cardiac arrest |
| 10. Identify the three parts of a closed drainage system: | collection, water seal, suction |
| 11. When you prepare the closed drainage system, into which chambers do you instill sterile water? | WATER SEAL and SUCTION |
| 12. What position would you place the patient to insert a chest tube? | lean over table or lateral supine |
| 13. The tube is placed differently depending on the type of problem. Pneumo is ? | inserted high and anteriorly |
| 13. The tube is placed differently depending on the type of problem. Hemo/emyema is ? | low and posteriorly |
| How is suction applied for each of the following? Wet suction? | = increase suction on external source for bubbling in chamber. Gentle continual suctioning |
| How is suction applied for each of the following? Dry suction? | 80 mm of mercury |
| How is suction applied for each of the following? Suction to gravity? | leave open to air |
| What type of dressing is applied over a chest tube insertion site? | air tight occulusive |
| 17. What must you do with all connections? | secure |
| 18. How is placement confirmed post chest tube insertion? | chest x-ray |
| 19. In providing follow-up care, what signs might indicate a tension pneumothorax has occurred? | Decrease BP, Increase pulse and Increase respiratory |
| signs might indicate a tension pneumothorax has occurred? Decrease BP, Increase pulse and Increase respiratory caused by | Decrease Cardiac output (hypotension) |
| 21. Must the patient with a chest tube remain very still and not cough? | Cough, deep breath every 2 hours, check pain |
| 23. What would you palpate around the dressing of a chest tube for? | SQ emphysema |
| 24. What position would you place the patient with a chest tube | respositionQ2H, high fowlers or semi fowlers |
| 25. How often would you monitor the output (drainage) from a chest tube? | Hourly, call if > 100/hr |
| 26. If there is so much drainage and the drainage system fills completely, what would you need to do to attach a new drainage system to the chest tube? | Prepare new system, clamp chest tube, quickly disconnect, reconnect, unclamp |
| 27. What should the water level in the water seal do with inspiration and exhalation? | TITALING. a. Rise and fall with resp., raise with inspiration, return to baseline with exhalation. If this doesn’t happen, then obstruction (kinked, clogged tube, this is an absence of titaling) |
| 28. If there is bubbling in the water seal, what complication might it indicate? | AIRLEAK. a. Cough, air leak, exhale. Don’t clamp for more than 10 seconds, if bubbling persists then problem on outside, if stops, then problem on inside of patient. Tighten loose connections, keep water level at proper amount, may have to add |
| 29. What is a clamp used for on a chest tube? | Check for air leaks |
| 30. With wet suction, what might happen to the water level over time? | EVAPORATION Decrease, need to add |
| 31. What might the physician order prior to the removal of a chest tube? | Clamp tube to assess, chest x-ray for affirmation of lung inflammation |
| 32. During the removal of a chest tube, the physician would have the patient do what? | Perform the valsalva maneuver and bear down to prevent air from rushing into pleural space. Then cover with petrol and 4 x 4 guaze. Valsalva maneuver to increase pressure |
| 33. Why is the valsalva maneuver done during chest tube removal? | prevent air from rushing into pleural space. |
| 34. Upon removal of a chest tube, what would the wound be covered with? | Then cover with petrol guaze and 4 x 4 guaze with tape for 24 hrs |
Created by:
bryantd9
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